Articles Posted in Public Benefits

The Supreme Court held that “medical assistance” provided to Medicaid recipients includes costs for room and board and other “nonmedical” expenses at nursing facilities, and therefore, those costs can be recovered from the recipient’s estate. In this case, the Nebraska Department of Health and Human Services (DHHS) filed a petition for allowance of a claim for services provided to the decedent while he resided at two different nursing homes. The county court sustained DHHS’ motion for summary judgment, concluding that the services defined as room and board fell within the parameters of services provided under the Medical Assistance Act. The Supreme Court affirmed, holding that DHHS was statutorily authorized to recover the sums it paid for room and board costs and other expenses from the decedent’s estate. View "In re Estate of Vollmann" on Justia Law

Brayden O. was a seventeen-year-old girl who suffered from Coffin-Lowry Syndrome and other disabilities. Brayden had been receiving home and community-based waiver services through the Medicaid division of the Nebraska Department of Health and Human Services (DHHS) for almost a dozen years before the DHHS determined that Brayden no longer met the necessary qualifications for such services. Merie B., Brayden’s mother, appealed DHHS’ determination, which was affirmed after an administrative appeal hearing. The district court affirmed. On appeal, the Supreme Court reversed and remanded with directions that the district court order DHHS to reinstate waiver services to Brayden, effective as of the date services were originally terminated. On remand, Merie requested reimbursement for expenses she incurred due to the wrongful termination of Brayden’s services, along with attorney fees. The district court granted the request and entered judgment against DHHS in the amount of $76,260.48. The Supreme Court reversed, holding that the district court was without authority to expand the mandate in Merie B. I and hold an evidentiary hearing on Merie’s “Motion to Determine Expenses.” View "Merie B. on behalf of Brayden O. v. State" on Justia Law

Brian Shaffer, who had severe autism and chemical sensitivities, resided with his mother, Delores Shaffer, who was paid to provide private duty nursing (PDN) care to Brian. In 2011, Brian’s Medicaid coverage was transferred to Coventry Health Care of Nebraska, Inc. When Coventry determined that the nursing services were not medically necessary, Shaffer requested a State fair hearing with the Nebraska Department of Health and Human Services. Coventry participated in the administrative proceedings, at which a hearing officer concluded that the PDN services were not medically necessary. Delores sought judicial review of the order, but the petition did not name Coventry as a respondent. The district court reversed the order of the Department, finding the PDN services that Delores provided to Brian were medically necessary. Coventry appealed. The Supreme Court vacated the order of the district court, holding that Coventry was a “party of record” at the State fair hearing and therefore a necessary party in the subsequent appeal to the district court, and the failure to make Coventry a party to the appeal deprived the district court of jurisdiction. View "Shaffer v. Neb. Dep’t of Health & Human Servs." on Justia Law

After her Father's death, Mother underwent intrauterine insemination using Father's cryopreserved sperm. The procedure was successful, and Mother gave birth to a child. Mother subsequently applied to the Social Security Administration (SSA) for surviving child's insurance benefits on behalf of the child. SSA denied the application. An ALJ decided that the child was entitled to child's insurance benefits on Father's Social Security record. SSA's appeal council reversed. On appeal, the U.S. district court certified the following question to the Nebraska Supreme Court: "Can a child, conceived after her biological father's death through intrauterine insemination using his sperm, and born within nine months of his death, inherit from him as the surviving issue under Nebraska intestacy law?" The Supreme Court answered in the negative, holding that under the relevant Nebraska statutes, a child conceived after her biological father's death cannot inherit from her father as surviving issue for purposes of intestacy. View "Amen v. Asture" on Justia Law

This case arose from the settlement of a personal injury lawsuit filed by Edward Smalley, who was seriously injured in a motor vehicle accident. Although Smalley qualified for Medicaid as a result of the accident, the Nebraska Department of Health and Human Services (DHHS), Nebraska's Medicaid administrator, refused to pay Smalley's outstanding medical bills prior to the disposition of his third-party liability claims. To facilitate a settlement of those claims, Smalley's attorney agreed that if DHHS paid the medical bills at the discounted Medicaid rate, Smalley would reimburse DHHS dollar-for-dollar out of the settlement proceeds. After DHHS paid the bills as agreed, Smalley objected to full reimbursement as contrary to federal law. The district court determined that under federal law, DHHS was entitled to reimbursement of only a portion of the Medicaid payments it had made. The Supreme Court reversed, holding that DHHS was entitled to full reimbursement. View "Smalley v. Neb. Dep't of Health & Human Servs." on Justia Law

The Nebraska Department of Health and Human Services (DHHS) provided Medicaid benefits for Virginia Lee Cushing during the final years of her life. After her death, DHHS filed a claim against Cushing's estate for recovery of the benefits pursuant to Neb. Rev. Stat. 68-919. The personal representative of the estate appealed from an order of the county court allowing the claim and awarding interest. At issue on appeal was whether DHHS timely presented its claim and, if so, whether it was proved as a matter of law. The Supreme Court concluded the claim was both timely presented and proved as a matter of law but modified the award of interest. View "In re Estate of Cushing" on Justia Law

The Nebraska Department of Health and Human Services (DHSS) determined that Darline Liddell-Toney was required to participate in a self-sufficiency program in order to receive benefits under the Welfare Reform Act, despite her documented disability. The district court affirmed the DHSSâ determination. Ms. Liddell-Toney appealed, arguing that the district court erred in finding that the DHSS provided sufficient evidence to prove she was not entitled to an exemption from participating in the program. The Supreme Court found that the evidence clearly indicated that Ms. Liddell-Toney was prevented from working for a substantial period due to her disability. The Court held that the district court erred when it affirmed DHSSâs determination that Ms. Liddell-Toney did not qualify for an exemption from participating in the self-sufficiency program. The Court reversed the judgment of the district court, and remanded the case for further proceedings.